The House passed the measure, removing a Senate-approved ban on Planned Parenthood funding, late Friday night. The Senate accepted the House's change Saturday afternoon, giving it a final 26-21 vote. The measure now heads to Gov. Kim Reynolds for her signature.

In addition to making billions of dollars worth of funding decisions, the legislation addresses a number of controversial policy issues including oversight of the state's privatized Medicaid program and legal liability for physicians in cases of "wrongful birth" or "wrongful life."

Legislators are pushing to close the 2018 legislative session this weekend, and the health and human services budget bill typically is among the last pieces of legislation to gain approval for the year.

The spending and policy measure passed the Senate 27-20 with all Republicans in favor and all Democrats opposed, sending it to the House. Near midnight, the House, which is also controlled by Republicans, approved it on a 55-35 vote. But the changes the House wrought meant the Senate had to re-approve it. It did so Saturday.

The measure includes $1.8 billion from the state's general fund, plus $420 million from other funds, for the fiscal year starting July 1.

It provides money for the Iowa Department of Human Services, Iowa Department of Public Health, Department on Aging, Department of Veterans Affairs and the Iowa Veterans Home.

Heated Senate debate on Medicaid management

Friday the Senate narrowly rejected an amendment proposed by Sen. Pam Jochum, D-Dubuque, to remove some patients from privatized managed care plan. She called for shifting long-term care patients back to traditional fee-for-service medical providers with government oversight. Her proposal failed by one vote.

Jochum said Iowans such as her 40-year-old daughter, Sarah, who is developmentally disabled, are poorly served by the privatized Medicaid program implemented by former Gov. Terry Branstad. She said she also wants to help disabled Iowans who are quadriplegic or have long-term illnesses such as multiple sclerosis and Parkinson's disease.

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Sen. Pam Jochum, D-Dubuque.(Photo: William Petroski/The Register)

Jochum and other Democrats said they often hear complaints that Medicaid recipients are being denied health care services and medical providers are not being paid in a timely manner.

"I wish privatization had worked. But after two years it is clear ... It isn't working" for thousands of Iowans, Jochum said.

"Privatizing Medicaid has made it almost unbearable for families," Jochum added. "They are fighting all the time to get kids the services they had prior to the privatization of Medicaid."

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Four-year-old Tatum Woods, of Vinton, needs a special walker to get around but it took six months for his family to navigate the Medicaid system and get the equipment he needs.
Kelsey Kremer / The Register

Senate Republicans suggested they were willing to study Jochum's proposal after the session. But they warned against immediately removing long-term care patients from Medicaid manage care, saying the shift could carry an additional cost of $40 million or more for the state fiscal year that begins July 1.

"You can’t make a change until you know what it will cost," said Sen. Michael Breitbach, R-Strawberry Point. "We have to provide services to these people. If you can’t pay for it. you can’t provide it.”

Senate Democrats said Republicans were already accepting budget uncertainty with the Medicaid program because contracts haven't been finalized with managed care firms for the upcoming year. The spending bill provides for a $55 million increase in Medicaid funding, but the actual cost could exceed $100 million, Democrats said.

House reverses ban on Planned Parenthood sex ed grants

The Senate bill originally included language blocking Planned Parenthood of the Heartland from obtaining grant money for for three sex education programs.

Those grants provide funding for the Personal Responsibility Education Program, Abstinence Education Grant Program and the Community Adolescent Pregnancy Prevention and Services program.

Planned Parenthood of the Heartland received $305,814 through the three grant programs this year, said Planned Parenthood spokeswoman Becca Lee.

Sen. Mark Costello, R-Imogene, who chairs the Senate's Health and Human Services Appropriations Subcommittee, said the change would redirect funding away from Planned Parenthood, which provides abortions, and toward other groups.

"We are not getting rid of sex education. We are asking others to provide it and probably better than Planned Parenthood," he said.

The proposal came just as Gov. Kim Reynolds signed legislation outlawing most abortions in Iowa. Critics questioned why the state would restrict access to sex education that could help prevent unwanted pregnancies.

But once the bill arrived in the House, lawmakers quietly amended the bill to strip out that language and allow Planned Parenthood to access those grants. That was approved by a 88-2 vote, with Rep. Sandy Salmon, R-Janesville, and Rep. Skyler Wheeler, R-Orange City, opposed.

Last year, the Republican-controlled Legislature created a new state-run family planning program which blocked funding to Planned Parenthood and other organizations that provide abortions. That situation is unchanged under this budget bill.

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A new Iowa Poll looks at how residents feel about defining life at conception and funding to Planned Parenthood.
Michael Zamora / The Register

Wrongful birth damages prohibited

The health and human services spending package includes a version of a bill supported by social conservatives to prohibit a cause of action in a lawsuit and the awarding of damages on behalf of a person based on a "wrongful birth" claim that, but for an act or omission of the defendant, a child or a person bringing the action would not or should not have been born.

The wrongful birth prohibitions would apply to any claim regardless of whether the child is born healthy or with a birth defect, disorder or other adverse medical condition. However, the prohibitions specified in the HHS bill would not apply to:

A civil action for damages for an intentional or grossly negligent act or omission, including any act or omission that constitutes a public offense.

A civil action for damages for the intentional failure of a physician to comply with the duty to provide a patient with all information reasonably necessary to make decisions about a pregnancy.

House requires doctor visits for foster kids

Families that receive state financial assistance to foster or adopt children will be required to document annual doctor visits, under an amendment added to the bill by the Iowa House.

The change is intended to create a new layer to the state's child welfare safety net following the high-profile deaths of two teenage girls, both of whom allegedly were abused and neglected by their adoptive families.

"Had there been one more set of eyes that they had to check in with, they might have caught or noticed the treatment that these girls were receiving," said Rep. Vicki Lensing, D-Iowa City.

Iowa spent about $42 million in fiscal year 2017 to provide subsidies to families who adopt difficult-to-place children or children with special needs out of foster care. According to an agency report, 10,518 children were eligible for those subsidies in July 2016, and payments averaged about $7,700 annually per child.

Sabrina Ray, who died in May, and Natalie Finn, who died in October, both had parents who were collecting those subsidies.